title: Prolonged dose-dense epirubicin and cyclophosphamide followed by paclitaxel in breast cancer is feasible.
abstract: OBJECTIVE
  We conducted a pilot study of dose-dense epirubicin/cyclophosphamide (EC) x 6 --> paclitaxel (P) x 6 with pegfilgrastim. A previous dose-dense trial of FEC (5-fluorouracil [5-FU]/EC) x 6 with filgrastim --> by weekly paclitaxel alternating with docetaxel x 18 was not feasible because of pneumonitis (with dose-dense FEC) and pericardial/pleural effusion (taxane phase). Dose-dense EC (without the 5-FU) is not associated with pneumonitis, and dose-dense paclitaxel (alone) is feasible. Primary objective was feasibility.
  
  
  METHODS
  Patients with resectable breast cancer were enrolled, regardless of surgery status, tumor size, or nodal status. Treatment regimen consisted of every-2-week EC (100/600 mg/m2) x 6 --> by 2-weekly P (175 mg/m2) x 6 with pegfilgrastim 6 mg on day 2.
  
  
  RESULTS
  Between November 2004 and May 2005, 38 patients were enrolled. The median age was 47 years (range, 30-72 years); 33 of 38 (87%) were treated in the adjuvant setting and 27 of 33 (81%) had involved nodes (range, 1-46); 5 of 38 (13%) were treated pre-operatively; 33 of 38 (87%) completed all chemotherapy as planned; the remaining patients (13%) had treatment modifications for toxicity. Febrile neutropenia occurred in 6 of 38 patients (16 %) and only during EC. There were 12 hospitalizations in 9 of 38 patients (24%) enrolled.
  
  
  CONCLUSIONS
  Dose-dense every-2-week EC x 6 --> P x 6 with pegfilgrastim is feasible based on our prospective definition.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. dangc@mskcc.org
authors.forename: Chau
authors.initials: C
authors.lastname: Dang
authors.forename: Gabriella
authors.initials: G
authors.lastname: D'Andrea
authors.forename: Diana
authors.initials: D
authors.lastname: Lake
authors.forename: Steve
authors.initials: S
authors.lastname: Sugarman
authors.forename: Monica
authors.initials: M
authors.lastname: Fornier
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Moynahan
authors.forename: Theresa
authors.initials: T
authors.lastname: Gilewski
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.forename: Nancy
authors.initials: N
authors.lastname: Mills
authors.forename: Tiffany
authors.initials: T
authors.lastname: Troso-Sandoval
authors.forename: Roshini
authors.initials: R
authors.lastname: George
authors.forename: Mark
authors.initials: M
authors.lastname: Robson
authors.forename: Maura
authors.initials: M
authors.lastname: Dickler
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Panageas
authors.forename: Larry
authors.initials: L
authors.lastname: Norton
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D010865:Pilot Projects
chemical_list: D015251:Epirubicin; D003520:Cyclophosphamide; D017239:Paclitaxel